“CMS’s effort, launched by Obamacare, to use the leverage of Medicare reimbursement to impose and control a favored model of health care delivery is bound to fail, but only after increasing the angst of providers and patients and dissipating large amounts of resources—money, time, and brainpower. It blocks the development of other ideas for reforming health care delivery. However, changes in the proposed regulations to fix the anomalies and problems discussed above, and numerous other provisions like them not discussed here, would not be sufficient to rescue the scheme. The Shared Savings Program and its ACOs are fatally flawed by the overweening assumptions embedded in the PPACA itself.”
“The Patient Protection and Affordable Care Act (PPACA) is not so much a set of norms to regulate conduct as an authorization to administrators to produce norms to regulate conduct. Implementation of the Act will require many years and literally thousands of administrative regulations that will determine its substantive content and coverage. Under current law, those regulations will be promulgated through so-called informal rulemaking procedures, which offer very limited opportunities for public input.”
“For a while, backers of last year’s health care overhaul have argued that it will become more popular as more people are exposed to its benefits. In particular, they’ve hoped that the supposed consumer protections that were front-loaded into the law’s implementation schedule would bolster the law’s sagging popularity. It hasn’t happened. A new poll by the Kaiser Family Foundation suggests one reason why that might be the case: ‘Only 20 percent of people believe consumer protections will get better under the law, while most others think protections will stay the same or get worse.'”
“One proposed departmental rule deals with what may become a centralized database containing patient medical records and pharmaceutical claim information. It’s an extremely technical issue but Section 153.340 of a new HHS proposed rule dealing with Obamacare mandates that individual states (or the department) collect ‘raw claims data sets’ from all insurers on all people with private coverage purchased either individually or through small employers, which includes that obtained from the new state exchanges the law requires be created.”
“The Independent Payment Advisory Board (IPAB) was created based on the premise that decisions about the pricing of health benefits offered by Medicare are simply too contentious to be adequately handled by our present political system. But these decisions are precisely the kinds of consequential choices that should be subject to close public scrutiny and an open, rigorous, and transparent decision-making process that engages with Medicare’s stakeholders. Changes to the way Medicare pays for and covers medical services affect too many people in significant ways to be made behind the closed doors of an insulated committee.”
“Democrats don’t use such hyperbole, but more than half a dozen have signed on as cosponsors of a bill that would repeal the board. And many more, particularly Democrats in the House, never supported creating the board in the first place… [I]t could end up driving Medicare payments so low that providers will simply leave the program, or else go bankrupt if they can’t.”
“ObamaCare doesn’t just create IPAB. It also sets in place a series of barriers designed to make it extremely difficult to repeal. So if Congress wants to get rid of IPAB, it will have to jump through a complex set of hoops first. That means acting swiftly and with great unity. The health care overhaul contains a provision labeled Joint Resolution Requirements to Dissolve the Board that lays out exactly the steps that Congress must follow if it wants to take down IPAB. The provision lays out in great detail what a joint resolution to dissolve IPAB would have to look like, and then sets out a further requirement that it must be introduced between January 1 and February 1, 2017—meaning Congress would have to act in just a few working days.”
“IPAB is fatally flawed, structured to punish innovative health care providers and threaten seniors’ access to care — while leaving the largest sources of Medicare spending untouched. It continues Washington’s obsession with price-fixing in Medicare’s separate ‘silos’ rather than changing the incentives that have led to rampant overspending, fraud and uneven care quality.”
“Clearly, the IPAB is unprecedented in the
power given to unelected officials to direct
hundreds of billions of dollars in federal
spending. The IPAB will give unelected,
unaccountable government appointees the
power to make decisions about payment
policy in Medicare that will ultimately
determine whether millions of seniors have
access to the care they need.”
“After all, how can there be a moral case for a 2,700 page bill that was shaped and molded by self-seeking interests, with no more regard for principle than one would find in a game of musical chairs? Isn’t asking for a moral defense of ObamaCare sort of like asking what is the moral case for the IRS Code?
Even if you believe that some of us have a moral obligation to others in the matter of health care, what does that belief have to do with legislation in which costs and benefits are strewn about with all the care of a drunken sailor? Isn’t the Affordable Care Act (ACA) self-evidently immoral? Or at least amoral?”